title: Positive Chlamydia trachomatis serology result in women seeking care for infertility is a negative prognosticator for intrauterine pregnancy.
abstract: BACKGROUND
  There are no prior studies that assess the non-in vitro fertilization (IVF) pregnancy rates in chlamydia serology-positive versus serology-negative women. Therefore, we wanted to determine whether a positive Chlamydia trachomatis immunoglobulin G serology result predicts reduced clinical pregnancy rates without IVF.
  
  
  METHODS
  A prospective observational study was performed at a university-affiliated reproductive center. A total of 1279 new infertility patients seen at the Continuum Reproductive Center between January 2007 and June 2009 underwent C. trachomatis immunoglobulin G screening. Charts were later reviewed for hysterosalpingography, laparoscopy, treatment cycles, and ultrasound evidence of an intrauterine pregnancy. The main outcome measure was non-IVF cumulative pregnancy rates.
  
  
  RESULTS
  Seventy (5.5%) of 1279 of the participants were found to have a positive chlamydia serology result. Serology-positive participants had significantly more tubal block on hysterosalpingography (37.5% vs. 10.1%, P = 0.001) and laparoscopically confirmed tubal damage (85.7% vs. 48.9%, P = 0.002). The percent of all participants who achieved an ultrasound documented clinical pregnancy, at our center, without IVF was significantly lower among Chlamydia-positive participants (10.0% versus 21.7%) in seronegative participants (P < 0.02). The hazard rate of non-IVF clinical pregnancy among chlamydia antibody testing-positive patients was 57% less than the rate of pregnancy among chlamydia antibody testing-negative patients (hazard ratio, 0.43; 95% confidence interval, 0.20-0.92). Both the per-cycle and the cumulative IVF pregnancy rates were equivalent in seropositive and in seronegative participants.
  
  
  CONCLUSIONS
  This is the first large study to report that a positive serology screening result is both predictive of tubal damage and a reduced cumulative pregnancy rate when excluding treatment with IVF.
authors.affiliation: From the *Continuum Reproductive Center, St Lukes-Roosevelt Hospital Center, and College of Physicians, Columbia University, New York, NY; †NYU Langone Medical Center, New York, NY; and ‡Department of Community and Preventive Medicine, Icahn School of Medicine at Mt Sinai, New York, NY.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Keltz
authors.forename: May-Tal
authors.initials: MT
authors.lastname: Sauerbrun-Cutler
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Durante
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Stein
authors.forename: Eric
authors.initials: E
authors.lastname: Gonzales
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005184:Fallopian Tube Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods*; D007074:Immunoglobulin G / Q000097:blood; D007247:Infertility, Female / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D007074:Immunoglobulin G